In Module 2, we looked at the five components of the Clinical Governance Framework; these are the areas where we can look to target improvement activity.

In Module 3, we developed a clinical governance vision; our “north star” that will guide all improvement activities to help us be the service we want to be in the future.

The Clinical Governance Improvement Program is how we achieve our Clinical Governance vision - the set of actions that aim to enhance the quality and safety of health care services through a planned suite of activities.

The Model for Improvement can be used to identify and plan those activities. Let’s take a look at how.

Imagine we are a rural primary care practice in Smithton concerned about our patients with chronic obstructive pulmonary disease - or COPD. Starting with the “thinking part” we ask ourselves the three fundamental questions:

What are we trying to accomplish? [The Goal].
Our goal is to increase the proportion of our active patients with COPD who have an influenza vaccine by 15% by 31 December 2023.

How will we know that a change is an improvement? [The Measure].
We will measure the percentage of active patients with COPD who have had an influenza vaccine.

What changes can we make that will result in an improvement? [The Idea].  
Our ideas for change include:

• Identifying active patients with COPD who have not had an influenza vaccine in 2022;
• Using this list, sending an SMS via the practice software recall function to remind patients to make an appointment to be vaccinated; and
• Sourcing and providing patient education resources on influenza vaccination in the clinic’s waiting room   

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By answering these three questions, we have developed a twelve-month goal for our COPD patients.

Now let’s apply the “doing part”, the PDSA Cycle to develop a short-term goal to track our progress.

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Taking our first idea, “Identify active patients with COPD who have not had an influenza vaccine in 2022” we plan what we will do.  

What are we going to do? We will conduct a search on the clinic’s system and identify active patients with COPD who have not had an influenza vaccine recorded in 2022

When are we going to do it? The activity will begin on 5 January 2023

Who will do it? Dr Smith’s receptionist, Jane

Where will it be done? At the clinic

What is our prediction? That 50% of the active COPD patient population will have had their influenza vaccine recorded in 2022

What data will we collect? We will collect data on the number of active patients with COPD and the number of active patients with COPD who have had an influenza vaccine

By stepping through the PLAN part of the PDSA Cycle, we have developed a short-term goal to help us achieve our twelve-month goal. When we execute the PLAN, we move through the three other parts of the PDSA cycle.

These two examples demonstrate how the Model for Improvement can be used to plan a Clinical Governance Improvement Program. It might seem a little daunting at first but will get easier the more you use it.

Your service will likely have its own process to follow when it comes to improvement activities. Before you begin, talk to your leadership to let them know what you intend to work on. They might also be able to guide you to where the hotspots of risk lie in clinical governance activities.